Elsevier

Ophthalmology

Volume 108, Issue 10, October 2001, Pages 1893-1900
Ophthalmology

Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration

https://doi.org/10.1016/S0161-6420(01)00754-0Get rights and content

Abstract

Objective

To examine (1) the prevalence of depressive disorders in community-dwelling adults with advanced age-related macular degeneration (AMD) and (2) the relationship in this population between depression, visual acuity, the number of comorbid medical conditions, disability caused by vision loss as measured by the National Eye Institute-Vision Function Questionnaire (NEI-VFQ) and the vision-specific Sickness Impact Profile (SIPV), and disability caused by overall health status as measured by the Sickness Impact Profile-68 (SIP).

Design

Analysis of cross-sectional baseline data from a randomized clinical trial.

Participants

Participants were 151 adults aged 60 and older (mean age, 80 years) with advanced macular degeneration whose vision was 20/60 or worse in their better eye.

Methods

Subjects were interviewed using measures of depression, disability, and chronic medical conditions. Visual acuity was obtained. Nonparametric correlation analyses and linear regression analyses were performed.

Main outcome measures

Structured Clinical Interview for DSM-IV (SCID-IV), Geriatric Depression Scale (GDS), NEI-VFQ, SIPV, and SIP.

Results

Of the participants, 32.5% (n = 49) met SCID-IV criteria for depressive disorder, twice the rate observed in previous studies of community-dwelling elderly. Over and above depression (GDS), visual acuity aided in prediction of the level of vision-specific disability (NEI-VFQ and SIPV).

Conclusions

Depressive disorder is a significant problem for the elderly afflicted with advanced macular degeneration. Further research on psychopharmacologic and psychotherapeutic interventions for depressed AMD patients is warranted to improve depression and enhance functioning. Over and above depression, visual acuity aided in predicting vision-specific disability. Treatment strategies that teach patients to cope with vision loss should be developed and evaluated.

Section snippets

Participants

Participants in this study were community volunteers enrolled between February 1998 and September 1999. This article examines screening and baseline data from a randomized clinical trial to further test the effects of a psychosocial intervention3 for people with advanced AMD. Individuals were recruited who met the following inclusion and exclusion criteria: (1) diagnosis by an ophthalmologist of AMD confirmed by fundus photographs; (2) visual acuity of 20/60 or worse in the better eye and

Descriptive analyses

As shown in Table 1, subjects were similar in age, ethnicity, and gender to those most likely to have advanced AMD. Almost 40% of the subjects were married at the time of the interview, and more than half of the subjects (61%) lived with at least one other person.

As shown in Table 2, visual acuity ranged from 20/60 to 20/8000. The median visual acuity was 20/200 (legally blind) in the better eye. Wilcoxon tests were performed to compare the disability scores of subjects with wet and dry AMD.

Discussion

Forty-nine of 151 elderly adults with advanced macular degeneration were found to have a depressive disorder. This rate (32.5%) is approximately twice as high as that found using similar standard diagnostic methods in general populations of older adults living in the community40, 41, 42 and is comparable to that found in outpatients with life-threatening diseases such as cancer and cerebrovascular disease.43, 44 To our knowledge this is the first study of AMD to examine the prevalence of

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    Supported in part by grant RO1 EY 11924 from the National Eye Institute, Bethesda, Maryland.

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